Hand and wrist

 

There are not many areas of the body placed under the same level of stress and strain as our hands and wrists. They are made up of 27 delicate bones, supported by a network of muscles, tendons, nerves and ligaments.

With such a large volume of moving parts, injuries and problems are common. Our team provides a comprehensive range of hand and wrist treatments.

Most conditions do not require surgery and can be treated with the help of our hand therapy team. This team includes occupational therapists and physiotherapists. They can provide treatments, including splinting and rehabilitation exercises. These are often very successful at treating many common conditions of the hand and wrist.

Despite these successful treatments, some patients fail to improve and might need other treatment, such and joint or tendon sheath injections or surgery.

More on what we do

From the initial GP or specialist referral, the history of your condition will be reviewed and assessed by one of our hand surgery consultants (senior doctors). 

At the earliest opportunity, you will be reviewed by the hand surgery team at the RD&E where a thorough history will be taken. You will then have an examination. In the majority of cases, a diagnosis can be made at this first visit. If there is uncertainty surrounding your condition you might be sent for further tests. Some of these tests will be available to you at the initial visit, for example X-rays.

Certain investigations, including CT scans, MRI scans and ultrasound scans, might need to happen at a later date.  You will receive a letter from these departments for the timing of your tests. Click here to find out more about these scans.

Once a diagnosis is made, treatment can start. Often this will be at the first visit. If necessary, our hand therapy team will be ready to meet you and start your treatment.

Steroid injections

If appropriate, you might also be offered treatment in the form of injections. Often they can improve symptoms and help to speed up your recovery.

Steroids are anti-inflammatory medication which can be injected into a joint or tendon lining where they can reduce inflammation and pain. They are safe and effective for certain conditions and are often used along with hand therapy to improve symptoms. Injections can be repeated if needed. The risks and benefits of these treatments will be discussed with you.

Treatments

If the non-surgical steroid injection treatment fail, surgery may be an option. We provide surgical treatments for a variety of conditions affecting the hand and wrist.

Here is a summary of the most common procedures: 

Carpal tunnel syndrome
This is a common condition which can cause tingling, burning, numbness and weakness of the hand. It is caused by compression of an important nerve as it enters the hand through the carpal tunnel. Treatment is initially with splinting and hand therapy. In early or mild cases steroid injections can help. In some cases, surgery is needed. Click here for more information.

Trigger digits
The tendons that bend each of our fingers and thumb travel through very tight and delicate tunnels. These tendons normally glide smoothly during finger movement but occasionally things go wrong. If the tendon gets inflamed (swollen) a thickened nodule can appear. This nodule can get stuck in the tunnel, causing the finger to get caught in a bent position. Occasionally it may get locked.

Treatments start with injections and hand therapy which can cure between 80 to 90 per cent of cases. If these treatments don't help, surgery might be considered. Click here for more information.

Dupuytrens contracture
Dupuytren’s (named after the French doctor first describing the condition) is a common condition that causes progressive contracture (bending) of the fingers. The cause of this condition is not fully understood but there seems to be a genetic association. It tends to run in families and is more common in those of north European descent.

The condition often causes a nodule (hard lump) in the palm or fingers which can occasionally be tender. However, the discomfort will almost always resolve. These nodules can get larger and form thickened cords that over time can pull the finger into a bent position.

In some individuals the contractures can progress and lead to functional impairment. You might be unable to lay your hand flat on a table or open your hand wide enough to hold on to certain objects. This can lead to a loss of ability to perform certain tasks, can interfere with work, hobbies or self-care tasks.

There is no cure for the condition but the position of the digits can be improved with surgery. Unfortunately, and unusually for hand conditions there is no benefit from non-surgical treatments. Click here for more information.

Arthritis
Arthritis of the hand and wrist is extremely common and most of us will develop symptoms of this at some point during our lifetimes.

What is arthritis?
Normally our joints are covered in a thick layer of cartilage which is a smooth white tissue that allows our joints to glide during movement. Arthritis occurs when this cartilage thins out and can be lost completely. This leads to bone rubbing on bone, causing stiffness and pain.

Who gets arthritis?
Arthritis is more common with increasing age but can occur at any age. The most common areas of the hand affected are the base of the thumb and the small joints in the fingers, however all joints can be affected in the hand and wrist.

Causes of arthritis:

  • Osteoarthritis – Wear and tear, more common with increasing age
  • Trauma – injuries around a joint can damage the cartilage leading to a very rapid and severe form of arthritis
  • Infection – infections within joints can lead to a rapid destruction of the cartilage again potentially causing a rapid and severe arthritis
  • Inflammation – We see this in conditions such as rheumatoid arthritis or gout. These are chronic conditions that can cause cartilage damage over a long period of time. These conditions are managed by the rheumatologists but our hand surgeons are often asked to advise on management of severely affected joints

What are the signs and symptoms of arthritis?

  • Pain – particularly during use of the affected joint
  • Swelling – arthritic joints will often become swollen and warm to the touch
  • Stiffness – as the arthritis progresses the joints will become stiff and loose movement
  • Deformity – joints can become deformed over time

Initially treatment is in the form of the following:

  • Painkillers and anti-inflammatory medication – simple medications such as paracetamol and ibuprofen can be very effective for pain caused by arthritis. Always check with your doctor that it is safe for you to be taking these medications
  • Hand therapy and splinting – the primary treatment of arthritis. Pain and stiffness can be successfully improved with many of the exercises and techniques you will be shown during these sessions
  • Steroid injections – these anti-inflammatory injections can give significant relief from pain and swelling. Often, they can be given in the clinic or else they will be performed by the radiology department where they can be guided into the joint using X-rays or ultrasound machines to improve the chances of the medication getting into the correct position
  • Surgery- once the above conservative measures have failed and pain is a significant issue surgery may be an option.

Surgery options include:

  • Joint fusions- where the worn out joint is removed and the two ends are fused together, fixing the joint in place. The body treats this as a fracture and heals the two bones together. This will give reliable pain relief but will stop that joint from moving at all, which means your body relies on the other joints for function. This usually involves a single operation
  • Joint replacements – this involves the insertion of an artificial joint to replace the old joint. This procedure will give good pain relief. You'll be able to have some movement in the joint, which can lead to improved function. The main disadvantage is that over time they can wear out and might need replacing. Ultimately if it fails, the joint may need to undergo a fusion
  • Joint excision-  this is commonly performed in arthritis affecting the base of the thumb. In this procedure, a bone called the trapezium is removed. This prevents the abnormal wear between the damaged joints and gives excellent pain relief.

Our team

Because it is such a complicated and intricate part of the body, hand surgery includes surgeons from both orthopaedics and plastic surgery backgrounds.

Our team is made up of the following surgeons:

Orthopaedic surgeons

  • Mr Oliver Stone (clinical lead for orthopaedic hand surgery)
  • Colonel David Standley

Plastic surgeons

  • Miss Paulina Witt
  • Mr Andrew Watts
  • Mr Patrick Gillespie

Where to find us

RD&E Wonford, Barrack Rd, Exeter EX2 5DW

Princess Elizabeth Orthopaedic Centre

Contact us

You can contact our consultants' secretaries on:

Mr Stone's secretary: 01392 404778

Colonel Standley's secretary: 01392 403565

Clinics

Our outpatient facilities are currently run through the Princess Elizabeth Orthopaedic Centre (PEOC) at the Royal Devon and Exeter hospital NHS Foundation Trust.

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